The impact of displacement on the expression of depressive disorder and social functioning among the war refugees.

Our research objective was to estimate the characteristics of major depressive disorder and social adaptation of women displaced during the war in Croatia in the early 1990s. We aimed to establish the relationship between major depressive disorder and displacement and study its impact on the outcome of depression in order to improve treatment and avoid possible complications. A group of 20 women, 35 to 55 years of age, displaced some time during the 199l.-1995. war in Croatia were compared to 27 women of the same age but with no experience of exile. All the patients suffered from major depressive disorder based upon DSM-IV diagnostic criteria. The Hamilton Rating Scale for Depression, the Zung Self Rating Depression Scale and the Social Adaptation Self-evaluation Scale were used. The objective intensity of depression of the displaced significantly decreased over time but not their personal experience of depression. All depressed patients manifested poor social adaptation. Many aspects of social functioning remained poor even after the improvement of depressive disorder. Displacement characteristics were: the length of time spent in exile, the place, and the circumstances of displacement regarding the members of the family accompanying the displaced women. These characteristics significantly influenced the expression of their major depressive disorder as well as social functioning. Displaced persons/refugees are at high risk of developing depressive disorder. Recognition of all risk factors and early diagnosis of depressive disorder followed by appropriate treatment could decrease the risk of chronic and complicated depression as well as the risk of poor social adaptation.

Pharmacologic side effects and/or neurologic disorder: case report.

The authors presented a patient with schizophrenia and with early parallel development of neurologic symptoms. At first, symptoms were manifested by extrapyramidal syndrome due to appliance of typical neuroleptics. Therefore, therapeutic approach was diverted to implementation of atipycal antiypsychotics. Consequently patient developed orofacial diskyinesias which progrediated in unilateral choreo-atetoid movements. This followed two hospitalizations for diagnostic workup and correction of therapy. Only repeated brain MR showed moderate cortical atrophy. However, even with different therapeutic changes and approaches, we were not able to reach any significant shift neither in psychiatric nor neurologic disturbances. The resistence on pharmacologic threapy led to suspicion of parallel development of neurologic disorder in form of Huntington chorea. Still remains the question whether primary neurologic disorder provoked psychotic process or there were two separate disorders where pharmacologic intervention accelerated expansion of neurologic disorder.

Comorbidity of depressive and dermatologic disorders - therapeutic aspects.

Depressive disorders are more common in the population affected with dermatologic disorders. Comorbidity of depression and dermatologic disorders is around 30%. The correlation between depressive and dermatologic disorders still remains unclear. In psychodermatology three disorders are described: a) psychophysiological disorders (both disorders induced and maintained by stressors), b) secondary psychiatric disorders (mental disorder as a result of skin leasions and treatment) and c) primary psychiatric disorders (skin alterations as a result of mental disorders and treatment). In depression and dermatology disorders in which certain precipitating factors are required thereby causing alteration of the patient's immunological identity causing a combination of hereditary features and ones acquired through adaptation occur to cause the disorder to develop. The cytokines are vital in the regulation of the immunology response and are also mediators of non-infective inflammatory processes leading to recurrent hormonal secretion affecting the function of the vegetative and central nervous system leading to so called "sickness behaviour", marked by loss of appetite, anhedonia, anxiety, decrease of concentration and interest along with other changes which generate a picture of depressive disorder. Treatment of depressive and dermatologic disorders is complex and requires an integral therapeutic approach encompassing all aspects of both disorders and their comorbidity. Therefore therapeutic success lies in a team approach to the patient under the auspice of consultative-liason psychiatry by setting the frame for efficient collaboration and bridging the gap between the mental and the physical in everyday clinical practice.

Second generation antipsychotics and risk of diabetes type II--comparison between olanzapine and risperidone.

Differences in the glucose metabolism were examined and analysed in this study between patients treated with olanzapine and risperidone in comparison with healthy volunteers. The aim of the study was to determine differences of the impaired glucose metabolism in the study groups as well as to point out to the possible mechanisms which bring to these differences. To the group of 15 schizophrenic patients treated with olanzapine, and group of 15 schizophrenic patients treated with risperidone and to 14 healthy volunteers oral glucose tolerancy test is applied in order to determine the level of the impaired glucose tolerance. In the group of the patients treated with olanzapine glucose tolerance was impaired in 33% of the patients, while in the group of the patients treated with risperidone in 20%. Impaired glucose tolerance mostly manifested as hyperinsulinemia. Authors discussed about possible mechanisms responsible for the impaired glucose tolerance in the patients treated with new antipsychotics. Authors conclude that insulin resistance is the main mechanism for development of the diabetes type II in the schizophrenic patients treated with antipsychotics. Insulin resistance is the result of the multiple effects of the antipsychotics, among which most common are: increased body mass and direct involvement of the antipsychotics in the glucose metabolism.

Newer antipsychotics and glucose metabolism: a comparison between olanzapine and risperidone.

In order to estimate the degree of glucose tolerance impairment, oral glucose tolerance test was conducted in the group of 15 schizophrenic patients taking olanzapine, the group of 15 schizophrenic patients taking risperidone and in the group of 14 healthy volunteers. In the olanzapine group the tolerance was impaired in 33% of the patients, contrary to the risperidone group in which impairment amounted to 20% of the patients. The authors discuss possible mechanisms responsible for impaired glucose tolerance in patients taking newer antipsychotic drugs.

Tattoo and personality traits in Croatian veterans.

To examine whether tattooed patients, treated for posttraumatic stress disorder (PTSD) caused by war at the Ward for Psycho-trauma of the Clinical Hospital Osijek, differ from non-tattooed patients by certain personality traits. The study was conducted on one hundred Croatian veterans who were divided into two groups with respect to the presence/ absence of tattoo. To assess the symptoms of PTSD, the Clinical Administered PTSD Scale (CAPS-2) was used for all subjects. To assess personality traits the following psychology tests were applied: Purdue non-verbal IQ test, Minnesota Multiphasic Personality Inventory (MMPI-1), and Eysenck's Personality Questionnaire (EPQ/A and EPQ/IVE). With respect to the examined pre-traumatic variables and PTSD symptoms, the two groups manifested no differences. The non-tattooed group achieved higher scores on the IQ test (IQ=100) than the tattooed group (IQ=95). EPQ test showed results either above or below the norms on all scales that were applied. The tattooed group demonstrated significantly higher levels of impulsiveness, adventurism, empathy and neuroticism than the non-tattooed one (p < 0.05). In the group of 100 Croatian veterans treated for PTSD, 33 had tattoos and 67 did not. The results indicated more impulsiveness, adventurism / risk behavior, empathy and neuroticism in the tattooed group than in the non-tattooed group, while there was no significant difference in the intensity of the PTSD symptoms.

The influence of risperidone on cognitive functions in schizophrenia.

Introduction of the antipsychotics of the second generation (SGA) into the therapy of schizophrenia roused expectations that, finally, the cognitive dysfunction in schizophrenia could be eliminated by psychopharmacological therapy. The purpose of the study was to verify the effect of atypical antipsychotic risperidone on cognitive functions in schizophrenic patients. The study was carried out upon 48 male schizophrenic patients aged 21-47 years who were switched from the antipsychotics of the first generation (FGA) to the antipsychotic risperidone, due to intolerance, during the treatment. Intelligence, abstract and concrete thinking and mental speed, attention, and short-term non-verbal memory prior to the switch, one month after the switch, and three months after the switch to risperidone, were evaluated. One month after the switch the number of subjects with severe impairment of intellectual abilities decreased significantly from 62% to 15% and after three months the number was even lower-8%. The impairment of concrete and abstract thinking and mental speed also showed the same tendencies of decrease. The improvement of the cognitive functioning after the switch from the antipsychotics of the first generation to the antipsychotic risperidone is explained by removal of the antipsychotics of the first generation from the therapy and the consequential disinhibition of secondary cognitive impairments and by decreased average dose of anticholinergic and decreased number of patients who need anticholinergic therapy beside risperidone. The possibility of clear pro-cognitive effect of risperidone is suggested and its verification is proposed with strict control of other factors that improve cognitive functioning of schizophrenic patients during the treatment.